Screening and Evaluation Fees
| Description of Procedure | Fees |
|---|---|
| Limited Oral Evaluation-Problem Focused | $20 |
| Periodic Oral Evaluation | $20 |
| Comprehensive Oral Evaluation | $30 |
Radiograph Fees
| Description of Procedure | Fees |
|---|---|
| FMS (full mouth series of x-rays) | $45 |
| 1 periapical x-ray (PA), any additional PA | $5 / $5 |
| BWX (Bitewing x-rays) / 4 BWX | $15 / $20 |
| Panoramic x-ray | $45 |
Restorative Fees (Amalgam)
| Description of Procedure | Fees |
|---|---|
| One surface Amalgam (filling) | $65 |
| Two & Three Surface Amalgam | $70 - $75 |
| Four+ surface Amalgam | $85 |
Restorative Fees Anterior (Composite)
| Description of Procedure | Fees |
|---|---|
| One surface Anterior Composite | $70 |
| Two surface Anterior Composite | $80 |
| Three surface Anterior Composite | $90 |
| Four+ surface Anterior Composite | $100 |
Restorative Fees Posterior (Composite)
| Description of Procedure | Fees |
|---|---|
| One surface Posterior Composite | $75 |
| Two surface Posterior Composite | $85 |
| Three surface Posterior Composite | $95 |
| Four+ surface Posterior Composite | $105 |
Crown and Additional Related Fees
| Description of Procedure | Fees |
|---|---|
| All Porcelain / PFM Crown | $650 |
| Gold Crown- High Noble Metal Cast | $700 |
| Core-buildup / Cast (lab) Core Build-up | $85 / $160 |
Simple and Surgical Extractions
Extraction services are limited and are offered only when deemed clinically appropriate and at the discretion of the supervising dentist. Referral to an outside dental provider may be necessary.
| Description of Procedure | Fees |
|---|---|
| Extraction | $60 |
| Surgical Extractions | $135 |